Provider Demographics
NPI:1205483864
Name:AZAMVAGHEFI, BEHZAD (DC)
Entity type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:AZAMVAGHEFI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 ADELAIDE AVE APT 7216
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-2028
Mailing Address - Country:US
Mailing Address - Phone:469-569-5238
Mailing Address - Fax:
Practice Address - Street 1:3434 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8709
Practice Address - Country:US
Practice Address - Phone:214-304-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor